If there are any suspicious areas, a biopsy can be taken with the bronchoscope. Besides a biopsy, the doctor can obtain a sample called a washing. This is the collection of fluid from the secretions in the lung which can be evaluated for cancer cells. In addition, pictures and videos can be taken for future reference. This is usually done as an outpatient.

If the bronchoscope is unsuccessful in obtaining a diagnosis, or if the lung mass is not close enough to the larger lung passages to obtain a biopsy, a CT scan-guided biopsy may be performed instead. In this test, a CT scan is used to isolate a suspicious area and then a needle is introduced to the area of concern. Cells can be aspirated into the needle and examined microscopically on a slide (like a Pap smear) and read as cytology. This is usually done as an outpatient.

If that is unsuccessfull or if the abnormal area is in the mediastinum yuo may have to have another type of test called a mediastinoscopy. In this procedure, which requires general anesthesia, a small opening is made into the chest and a similar type of viewing instrument is introduced into the mediastinum, which is the area between the breast bone and the main breathing passages. This is a critical area in which the lymph nodes are often involved with cancer. They can be seen directly and a biopsy can be taken. This may be required to determine if you are a candidate for surgery. You will likely have to stay in the hospital at least overnight for this procedure.

Yet another way to obtain tissue is with a thorascope. In this test a small incision is made between the ribs, and still another type of special viewing instrument is placed inside, so that the doctor can see the lung tissue and obtain biopsies.

If these methods fail to yield a diagnosis, or it is determined that the mass must be removed regardless of the diagnosis, you may have to have diagnostic surgery. This operation is called a thoracotomy. It requires general anesthesia and a hospital stay.

The most important aspect for determining what treatment you can receive is to find out if your cancer is limited to the lung, if it has spread to the lymph nodes in the chest, or if it has spread (metastasized) to other parts of the body outside the lung.

This process is called staging. Most likely, you will be required to get the following:

• Chest x-ray - This will give some basic information on size, location and possible involvement of lymph nodes.
  
  
• CT and/or MRI scan of the lung - These tests should be done so that both the liver and adrenal glands can be seen. This is important as these are two areas to which lung cancer can spread.
  
  
• CT and or MRI of the brain.

Usually you will be given a contrast material (through a vein) that helps the radiologist to see more clearly all the different structures that are being looked at.
Be sure to tell your doctor if you are allergic to any medicines, especially iodine, or food such as shellfish.